MEDICARE: NIKKI C NOLET LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	108130	CA

General Provider Information

NPI Number	:	1487115903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI C NOLET LMFT

Provider Business Mailing Address
First Line	:	11340 W OLYMPIC BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1612
Country	:	US
Telephone Number	:	424-645-7705
Fax Number	:

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1612
Country	:	US
Telephone Number	:	424-645-7705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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Directions to “ NIKKI C NOLET LMFT” Practice Location

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